Dr. Maragakis is an infectious disease fellow at the Johns Hopkins University whose research is in the area of hospital epidemiology and infection control under the mentorship of Dr. Irish Perl. Through this award, Dr. Maragakis will conduct epidemiologic research on healthcare-associated antimicrobial-resistant gram negative rods (GNR) as a faculty member of the Division of Infectious Diseases at Johns Hopkins. She will continue to have the mentorship of Dr. Perl, an expert in epidemiologic and infection control research, and will also have the mentorship of Dr. Karen Carroll, an expert in microbiologic research. To complement her research and acquire skills to become an independent researcher, Dr. Maragakis will complete courses in the School of Public Health in epidemiology, biostatistics, ethics, and research methods. Antimicrobial-resistant GNR are a growing threat to patients and treatment options for these infections are limited. We hypothesize that healthcare-associated transmission of these organisms occurs not only among patients at a single institution, but among multiple healthcare institutions in a community, and that a strategy of targeted active surveillance will decrease their incidence. Dr. Maragakis' preliminary data show that strains of resistant Acinetobacter from The Johns Hopkins Hospital match strains from other healthcare facilities in Baltimore and that prior residence in a long-term care facility was a significant risk factor for acquisition of the organism in the hospital. Through this award, she proposes to determine the incidence of antimicrobial-resistant Acinetobacter and Pseudomonas in one acute care hospital, two community hospitals, and two long-term care facilities in the Baltimore area. She will then use molecular techniques to characterize the strains and will correlate this information with patient movement between the institutions. Finally, she will evaluate targeted active surveillance as a strategy to reduce transmission of these organisms within The Johns Hopkins Hospital. The combination of research, coursework in the School of Public Health, excellent mentorship of senior investigators, and the supportive environment at The Johns Hopkins University will provide Dr. Maragakis with the skills she needs to develop into an independent clinical investigator in epidemiologic research for the prevention of healthcare-associated infections.